Murray Ronan J, Lim Tien Tze, Pearson Julie C, Grubb Warren B, Lum Gary D
Department of Microbiology and Infectious Diseases, Royal Perth Hospital, G.P.O. Box X2213, Perth, Western Australia 6847, Australia.
Int J Infect Dis. 2004 Sep;8(5):275-83. doi: 10.1016/j.ijid.2003.11.008.
Community-onset infections caused by methicillin-resistant Staphylococcus aureus (COMRSA) are being increasingly reported worldwide.
A retrospective study was performed of 14 patients with 15 episodes of COMRSA bacteremia (COMRSAB) admitted to the Royal Darwin Hospital, Northern Territory, Australia from 1998 to 2001. Isolates from COMRSAB episodes underwent extended susceptibility testing and molecular typing by pulsed field gel electrophoresis and allotyping of the staphylococcal cassette chromosome mec (SCCmec) region by polymerase chain reaction.
The proportion of community-onset S. aureus bacteremia episodes that were due to COMRSA increased from 9% in 1998 to 20% in 2001. The clinical features of COMRSAB were similar to those seen with methicillin-susceptible strains, including sepsis, endocarditis and metastatic infection. Ineffective empiric antimicrobial therapy was administered in the majority (80%) of episodes. All COMRSAB isolates tested contained allotype IV SCCmec, which is commonly found in community isolates of MRSA and rarely found in isolates from healthcare-associated MRSA infection.
The increasing incidence of COMRSAB in our region has resulted in the addition of vancomycin to standard empiric therapy in certain patients with suspected S. aureus bacteremia acquired in the community.
耐甲氧西林金黄色葡萄球菌引起的社区获得性感染（COMRSA）在全球范围内的报告日益增多。
对1998年至2001年期间澳大利亚北领地皇家达尔文医院收治的14例患者的15次COMRSA菌血症（COMRSAB）进行回顾性研究。对COMRSAB发作的分离株进行了扩展药敏试验，并通过脉冲场凝胶电泳进行分子分型，通过聚合酶链反应对葡萄球菌盒式染色体mec（SCCmec）区域进行别型分析。
社区获得性金黄色葡萄球菌菌血症发作中由COMRSA引起的比例从1998年的9%增加到2001年的20%。COMRSAB的临床特征与甲氧西林敏感菌株相似，包括败血症、心内膜炎和转移性感染。大多数（80%）发作中经验性抗菌治疗无效。所有测试的COMRSAB分离株均含有IV型SCCmec别型，这在社区获得性MRSA分离株中常见，而在医疗保健相关MRSA感染的分离株中很少见。
我们地区COMRSAB发病率的增加导致在某些社区获得性疑似金黄色葡萄球菌菌血症患者的标准经验性治疗中增加了万古霉素。
